DEP/DUA/1/32/17 (Transcript version)

William Davidson

1783

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Wm Davidson June 18^th 1783.

With regard to affect to which this patient subj must own am somewhat at a loss.

Have not in former pract met with many inst which could be consid as corresp to pres.

Perhaps however would have though disease less singul. if prop. opport had been afforded of exam it.

But never happened that patient attackd with any of fits while we saw him at the Disp.

According howevr to acct given us disease consisted prin in any affect of Respiration.

And this return in fits partic freq. during the night.

These however always but of short contin

And while attackd without any manif cause so also spon. termin.

If this descript perfectly accurate disease of pres. patient does not exactly corresp. to any of affect of Respirat or order of [illegible] as have been calld, with which am acquainted.

But in its nature seems to app. most nearly to fits of Asthma.

And perhaps may view it as being a pecul. modif of that disease.

But whether of this kind, or not, can be little doubt that to be looked upon as being princip a nerv affect.

And as depend on an inordin action induced in some of the organs concernd in funct of Respir.

Of this abund. evid from transit nature as well as from freq. recurr.

And if farther proof wanting afforded in evid connex with other inord action

Partic dry cough & singultus with which this patient is at times also affected.

While these we are told never attended either with expector or vomit.

A circum serving to shew that these inordin actions of diaphg. more effect of pecul. irritability than of any local irritat

Not impos. that difficul of [respir] or Asthm. affect itself, which here occurrs, also immed depend on an inord action of diaph.

For on all hands allowed that diaphragm an organ princip conc in that funct.

But at same time many other parts also, from affect of which, such diffic fits of respirat as, here take place, may be supp. to proceed.

Thus may be induced from [const] either at extreme branches of bronchea or at larynx.

Of situat. some judgem might be formed both from app. during fits & likewise from feelings of patient.

But as had never opport of seeing fits & as inf. totally incap of describ. feelings would be improp to offer any conject on the subject.

Can only therefore state it as my opin, that this affect of respirat. conseq. of inordin action in some of respirat. organs.

Here however to be observd, that although this the princip, yet not only affect to which pat. subj.

Besides these fits, is subj. also to some degree of const. dysp.

And this we are told during whole course of compl. attended with hoarseness.

Not improb. therefore that in case of these, are to look for origin of other [affect].

And that the inordin action giving alarm fits, depends on pecul. state at Larynx giving hoarseness.

But besides these, still another circum also mentiond in hist of this case.

And not improb. that with this also, diff parts diff parts of affect already ment. have connex.

Erupt. viz of red pustules on diff parts of body.

That with cutan erupt. asthm. affect, often connected undeniab.

Every one much convers. in treat. must have met with many inst of this kind.

Nothing even more common than to obs fits of diff respirat. from sudden case of Psora.

And inst upon record where Psora & Asthma have altern with each other.

Still more common & less surp. to observe connex. with other erupt.

Accordingly with great prop. that among other species of Asthm Mr Sauv. has enum as one the [Exanthem]

While however on this ground suggest it at least as possib circum that such connex may take place yet think it more prob. that [altogeth] unconnected.

For in first place this tend. to erupt of much older date than other affect.

Had always prev. to greatr or less degree.

Had never been obs. either altern with erupt. asthm affect or encr. in prop to its severity.

And as far as I could observe was nothing diff. from what every day to be met with in infants of that age who in other respects enjoy best health.

Here then inclind to look upon this as a part of affect. free from danger & even hardly deserv. attent.

But with regard to progn. in [other] parts of compl. was formerly & still am more doubtful.

Would be, by no means surpr, if from fit of diff. respirat, suddenly arising to great height should be even unexp. cut off.

And as long as subj. to freq. returns of it cannot consid him as free from danger.

At same time after contin which has now had this less to be appreh. than at first.

No reason for susp. that future fits will be more viol than what have already passed.

Ground even for hoping that may be slighter.

At least this obs. to be case with a disease in some [respc] [illegible] Croup

Very generally first attack most severe

And but rarely that child falls victim to it who surv. first fitt.

Upon whole then hopes of this case rather fav. than otherwise.

And for these hopes better found when consid relief patient has had since came under care.

At same time after long contin which has already had very speedy recov. hardly to be lookd for.

And from reports inserted in Regis have no reason to flatter ourselves that progr. to recov. unif or unintr.

Aggrav of affect however prob to be consid as conseq. of very unfav weather which has of late taken place.

And while distress. to invalids in general may expect that will be partic so to those lab. under affect of Respirat.

Although patient had already arrivd at 17^th year of age yet hitherto no appear. of menst. disch.

And although period of commen not exactly fixd yet at a medium is before time of life now mentiond.

Nosol. indeed have diff. much [where] want of appear of menses at prop period or even obstr. after have once appeard judge strictly to be consid as disease or not.

Yet univ allowed that from both one & other cause an almost infin diversit of sympt of most anom & troublesome nature may arise.

While however want of menses is often observd as cause of many disease is also freq remarkd as conseq of [other]

Here then a quest of some impor to determine whether in pres case are to consid it as cause or conseq. of other affect

For probab. at least that unless from one or other of these circum would have already appeard

Here must observe that of the two inclind rather to latter opin.

Is indeed true that in this case no disease seems to have occurrd till about time that menst flux might have been expected.

But on other hand to be observd that affect did not begin with those appear which usually indic diseases from want of menses.

And to be remarkd that although in course, sympt much diversif. yet at commen of all cases very much the same.

Very gener. if not univ indicat of partial congest in uterine vessels occurring at regul. periods.

And not unfreq. of general pleth. as succeeding such partial congest.

To these might also add pains in region of uterus very gener occurring to certain degree & in some inst, with even great severity.

At pres. from exhausted appear of patient without any other cause of obstruct could as little expect [illegible] as in last stage of Phthisis.

And as far as we can learn this condit of habit has existed as early as any of obvious sympt.

That is took place as soon as menst. flux could have been expected.

Farther to be observd that although obv. ulcerat but for about 18^th months yet reason to pres. that disease much earlier in habit

And that really existed prior to usual period of appear of menses.

From all these consid then am inclind to consider scrophul. as being here origin disease

And to this from exhaust. of habit would referr want of menses at period of life when otherwise might have been expected.

As well indeed as extenuated habit. tendency to looseness, quickness of pulse & other sympt, indicat hectic state.

From this view of nature of disease cannot be disposed to give very fav. prognos.

And from influ which it has had on the habit as indic by last mentiond sympt. reason even for being affraid

Well known that scrophul sores even when entirely situat in gland or soft parts without any affect of bones are always danger obstin.

In pres case, from situat, although no certainty, yet reason to appreh. that this is really may be the case

And while disease well known obst. to resist artif remed patient has already passd that period of life at which natur cure prin occurs.

But if from these partic reason to fear obstin so other sympt induced give ground to appreh fatal tendency.

For after absorpt from scroph sores gives rise to hectic fever whether these sores seated in lungs or elsewhere are never without danger.

Upon whole then reckon it most probab. that this patient will at length fall victim to affect.

Yet on other hand recov even from pres. situat cannot be thought extraordin.

And of this greater prospect from change for better which seems to have taken place since patient came under our care

How far however this has in any degree been conseq of med which patn has taken since that time cannot with confid prop to say.

Before this patient came under our care had employd a pract. from which perhaps more freq. than any other matterial benef obt. in Scroph.

That is cold bathing conjoind with the drinking of Sea water.

These pract however although freq. benef. can by no means be repres as successful in every case

Nor can they be consid as always admissib.

Former, perhaps both, partic to be avoided where Scroph. affects lungs.

And perhaps in every case propriety of prosecuting them to be determ by [affect]

How far in the inst before us, prop. opportun for forming such a judgem was afforded by trial made cannot pretend to say.

But was at least opin of patient that all her affect aggrav. during use.

And although some ground perhaps for conject that opin of effects proceeded from avers to it, yet in this situat thought it advis to try another pract at least for some time.

On commen of treatment of this case began with use of extract of Acon

Was here exhib as conj with Soap & Extract of Gentian intended with no other view, than to give prop. form.

Of princip on which suppose the Aconite to operate, or of grounds on which suppose that may be useful in Scroph. need not now make any observat.

Sentim on this subject have already had opport of stating to you when treatd of case of Donald Robertson.

Here only may observe that in each pill extract introd to extent of gr s.

And of these one directed to be taken every morning & evening.

To this extent however seemd to be more than patient could easily bear.

Or at least she herself disposed to ascribe to it both gripes & encrease of looseness.

In this situat even on presumpt of its being cause of these sympt thought it advis to dimin dose.

But after finding that single pill born with ease again ordered two in the day.

And to this the rather led as sores during use of her med had put on more favourable appear.

While this contin to be the case shall be desir not only of persist in use but even of pushing it to greater extent than before.

And if under this course patient gets rid of affect. will I own consider it as strong inst of effic of the med.

If proves ineffect in place of using any farther meas at this place is my intent again to recommend to her the use of Sea Bathing.

And from greater warmth of season may now perhaps be able to bear it with less inconven than formerly.

And was with view to answering this intent that had recourse to Valer.

Of this artic sensib qualit strong & pecul.

And whatever be nature of impr. which gives to nerves, that has powerf influ as allaying inord mot, partic those arising from mobilit abund conf. by exper.

Do not indeed pretend that in own pract have always succeedd with it.

And that too even when given in very large doses.

This however do not consid as suff foundat for disreg it as med.

For in other inst have found it I think, attend with manif good conseq.

And have partic observd benef from it in hysteric or nerv. headachs.

Here therfore wishd to give it by itself fair & full trial

And with this view begun by order. it to patient to extent of Jii [b] ind.

This quantity as much as imag stomach of patient at first able to bear.

Was however intent, partic if any encourag to persist in use, to encrease both quantity of dose, & freq of repet.

Or at any rate to persist regul in employm if not rest. by other meas.

For space of week was employd without any inconven.

But at same time without any benef.

And urgen of headach in partic such that gave very great distress to patient.

In this situat thought it more advis to have recourse to some med with a view of mitig of sympt than to trust to encrease of Valer.

For another week then directed Valer in former quantity, & with a view to radic cure.

While at same time directed for patin a mixt of Vol. Elix of Guaiac with L. [Liq].

In this formul, combind will [obser] what hold to be very powerf active stimul. with most powerful sedat of M. M.

From this combinat was by no means intent to obt. at same time both stimul & sedat effect

For that hold to be impossib.

But have already remarkd that both from stimul & sedat impress. Hyster fits anticip & Hyst. sympt counteracted.

And look upon combin of stimul & sedat as not so much destroy aff of each other as alter & modif impress.

Accord find that while opium comb. with cantharid, though pain lessened yet vesic excited.

And that opium again comb with Vol Alkali, in some habits whereby itself const. prod tend to delir has affect of inducing sleep, without such conseq.

Upon whole then consid these cont as altering nature of impress yet still giving strong or powerf. impress

And from pract in some cases have been disp to think that from such combin impress more to be obtaind than either from stimul or sedat by itself.

Was here therefore desirous of putting opin to test of farther trial.

Effect to be wishd for was from immed action on nerves of stomach

Directed exhib therfore on sugar rather than any menst.

As thus conveyd into syst in most concent. & active state.

While at same time free from danger of precip of Gua. from menst.

What has been effect however of this prescript have not learnd

And as patient has so long deserted us not hardly talk of other plans should pres be found ineffect.

May only in gener. observe that conceive this to be case in which something may be expect from ext applic of Aether. Wards Vol. Essence or like

And from internal use of Tonics as Peruv. Bark. Cinchon [illegible] or Salix alb.

And if resumes attend to some of these shall prob. have recourse

Pain however & uneasiness in latter way dep. very much on [illegible] of epispas. ointm employd.

And from some equal effect with much less distress to patient than from others.

With same proport of cantharid will act much more mildly when reduced to very fine powder.

But have still milder & with many habits no less effect ointm in what formd by extract active parts of cantharid by boiling.

And in this manner Ungt. Episp mitius of Ednr Pharm is prepared.

Where by this means disch can be supported have it at least in more const & unif manner than by [blist] repeated & some interv.

And consid benef which patient at first received should have rather wishd for it in pres. case.

But as in this disappointed though it more advis for short time to try some other meas. than have immed recourse to second blister.

Was then with view of relieving sympt by prom expect. that has recour to Squill pills.

These indeed consid as in some meas. adverse to this affect from tend which have to encrease secret.

But this more than counterballancd by their prom. excret.

And from fluid being disch before acquires viscid form absorpt of [these] parts, cough much less distress.

Is cheifly on these princip that would acct for benef from Squill pills in such affect.

And in many cases have seen patient derive very great advant from use

As far however as trials yet go this has not been the case

For at last report found that cough of patient rathr aggrav as otherwise

From this however was not disp immed to interm pills.

On contrary suppos. agrav from some accid cause & that more to be expected from squils if given to greater extent ordered dose to be double.

Unless however from this course derives very great benef. shall not think of trust to it alone.

But shall either conj it with repet of blisters, or endeav either by means formerly empl. or other meas to support perman. dischg.

And am in hopes that under this course affect will be allev if not removed.

But if other meas necess for prom expect shall prob. employ emet.

Or if blister in no degree dimin disch may have recourse to astring.

In these partic howevr must be directed by future occurr.